Enterprise Outsourcing for FQHC and RHC Networks and Community Health Centers

FQHCs are paid under a Prospective Payment System (PPS). The CMS FQHC PPS national base payment rate for 2025 is $202.65 per visit, adjusted up 34.16% to $271.88 for a new patient, an Initial Preventive Physical Exam, or an Annual Wellness Visit. RHCs are paid a cost-based All-Inclusive Rate (AIR) per qualifying visit, capped by a national Upper Payment Limit. The CY2025 RHC payment limit per visit is $152.00, adjusted annually by the Medicare Economic Index, with Medicare paying 80% and the patient or secondary payer covering 20%. Our billing pod runs both methodologies, applies the correct per-visit logic by site type, and reconciles wrap-around payments so no qualifying visit is underpaid.

Yes. We sign a single Business Associate Agreement at the health center organization level with a schedule of covered affiliated sites. New sites added mid-engagement are appended through a short addendum, not a fresh BAA. This mirrors the contracting workflow FQHCs and RHCs already run with Medicaid managed care plans and clearinghouses. Staffingly is SOC 2 Type II audited, HITRUST-aligned, and ISO 27001-aligned.

FQHCs must operate a Sliding Fee Discount Program based on the Federal Poverty Guidelines per the HRSA BPHC Compliance Manual, Chapter 9. Our intake and eligibility pod collects income and household-size documentation, maps each patient to the correct discount pay class against the current Federal Poverty Level brackets, and records the determination in your practice management system. Because roughly 90% of health-center patients have incomes at or below 200% of the Federal Poverty Level per HRSA, accurate sliding fee determination protects both compliance and self-pay revenue.

Yes. FQHCs funded under Section 330 of the Public Health Service Act must submit the annual HRSA Uniform Data System (UDS) report through HRSA’s EHBs. The CY2024 aggregate UDS report was due February 15, 2025, and the newer patient-level UDS+ submission for CY2024 data was due April 30, 2025. Our reporting pod assembles clinical, financial, and patient-demographic tables, runs the quality measure logic, validates against HRSA edit checks, and prepares both the aggregate UDS and patient-level UDS+ files for your team’s sign-off before submission.

In 2025 CMS unbundled G0511, and the grace period to keep billing G0511 ran through September 30, 2025. Beginning January 1, 2026, G0512 and G0071 are no longer reportable, so FQHCs and RHCs report the component codes instead. For Behavioral Health Integration that means codes 99492, 99493, 99494, and G2214 rather than a single bundled code. Our care management billing pod has already moved affiliated sites to the component-code workflow, maps each care management program to the correct codes, and tracks time thresholds so Chronic Care Management, Principal Care Management, and BHI claims pass clean under the 2026 rules.

Hourly, by the FTE, billed weekly. Three tiers: Front Desk at $399 per week per FTE for a single affiliated site, Full Health Center Stack at $349 per week per FTE for 5+ specialists across eligibility, billing, RCM, prior authorization, and reporting, and Enterprise Custom at $299 per week per FTE for networks above 25 FTE or multi-site FQHC organizations and Health Center Controlled Networks. No long-term lock-in, no percent-of-collections pricing, no minimums beyond the 2-Week Free Pilot, BAA Signed. Estimated cost savings are based on US Bureau of Labor Statistics wage data for front-office staff, medical billers, and patient-access representatives.

Yes. Our specialists are fluent across Epic Community Connect, eClinicalWorks, NextGen, and Athenahealth, plus the OCHIN-hosted Epic environment many community health centers run, and clearinghouse platforms such as Waystar and Availity. We also work in Microsoft Teams and Outlook for site coordination. After acquisitions or affiliations, a single FQHC network often runs more than one PM system, and our team logs into each one and applies the correct FQHC PPS or RHC AIR billing logic per site.

Yes. We run a network-wide credentialing and enrollment tracker covering Medicare, state Medicaid, Medicaid managed care plans, and commercial payers per site, plus CAQH ProView maintenance, NPPES updates, and NHSC site enrollment support. We also provide administrative support for FTCA deeming applications and renewals. This is enrollment and documentation support, not legal advice. CAQH attestations, license renewals, and re-credentialing cycles all feed one weekly health center report so a missed deadline does not turn into denied claims.

Community health centers serve roughly 1 in 4 Medicaid patients nationally while accounting for under 3% of total Medicaid spending per published Medicaid analyses, and Medicaid is roughly half of health-center revenue. A percent-of-collections model penalizes safety-net margins and creates incentives misaligned with mission-driven care. Hourly per-FTE billing gives you a predictable, fixed cost, keeps the savings inside your health center, and means our team works your full eligibility, sliding fee, billing, and reporting scope rather than cherry-picking the highest-dollar claims.

32.4 million people used HRSA-funded health centers in 2024 per HRSA, up from about 31 million in 2023, while the workforce has not kept pace. The NACHC 2024 workforce survey found 55% of community health centers report difficulty filling open positions and 86% say they cannot offer competitive salaries. AAMC projects a U.S. physician shortage of 37,800 to 124,000 by 2034, and over 80% of physicians practice in urban areas, widening the rural and underserved access gap. A remote, credentialed back-office team absorbs eligibility, sliding fee, billing, prior authorization, RCM, and HRSA reporting so internal staff can stay focused on patient care.